Key result
New model predicts four-year total cancer risk in CVD patients with a 0.63 C-statistic.
Why the study?
Cardiovascular disease and cancer share common risk factors, but prediction models estimating lifetime and 10-year cancer risk in patients with established CVD were needed.
Can lifetime and 10-year risk of total, colorectal, and lung cancer be accurately predicted in patients with established cardiovascular disease using readily available clinical predictors?
Cohort (n=16,602)
Yes
Can lifetime and 10-year risk of total, colorectal, and lung cancer be accurately predicted in patients with established cardiovascular disease using readily available clinical predictors?
Effect estimate: C-statistic 0.63 (95% CI 0.61-0.66)
Lifetime and 10-year risk of total, colorectal, and lung cancer can be reasonably estimated in patients with established CVD using simple clinical predictors, which may help guide lifestyle changes and screening.
May aid cancer risk discussions in CVD patients using routine data; leaves open external validation before guiding screening.
BACKGROUND: Cardiovascular disease (CVD) and cancer share many common risk factors; patients with CVD also may be at risk of developing cancer. OBJECTIVES: The aim of this study was to derive and externally validate prediction models for the estimation of lifetime and 10-year risk for total, colorectal, and lung cancer in patients with established CVD. METHODS: Data from patients with established CVD from the UCC-SMART cohort (N = 7,280) were used for model development, and from the CANTOS trial (N = 9,322) for model validation. Predictors were selected based on previously published cancer risk scores, clinical availability, and presence in the derivation dataset. Fine and Gray competing risk-adjusted lifetime models were developed for the outcomes total, colorectal, and lung cancer. RESULTS: Selected predictors were age, sex, smoking, weight, height, alcohol use, antiplatelet use, diabetes, and C-reactive protein. External calibration for the 4-year risk of lung, colorectal, and total cancer was reasonable in our models, as was discrimination with C-statistics of 0.74, 0.64, and 0.63, respectively. Median predicted lifetime and 10-year risks in CANTOS were 26% (range 1% to 52%) and 13% (range 1% to 31%) for total cancer; 4% (range 0% to 13%) and 2% (range 0% to 6%) for colorectal cancer; and 5% (range 0% to 37%) and 2% (range 0% to 24%) for lung cancer. CONCLUSIONS: Lifetime and 10-year risk of total, colorectal, and lung cancer can be estimated reasonably well in patients with established CVD with readily available clinical predictors. With additional study, these tools could be used in clinical practice to further aid in the emphasis of healthy lifestyle changes and to guide thresholds for targeted diagnostics and screening.
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Klooster et al. (2020) conducted a cohort in Established cardiovascular disease (n=16,602). Clinical risk prediction models was evaluated on Discrimination (C-statistic) for 4-year risk of total cancer in external validation (C-statistic 0.63, 95% CI 0.61-0.66). A newly developed risk prediction model estimated the 4-year risk of total, colorectal, and lung cancer in patients with established cardiovascular disease with C-statistics of 0.63, 0.64, and 0.74.
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